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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by banga on July 27, 2004, at 0:10:08
Hello!
Can anyone elucidate what the differences are between these three drugs? Clomipramine is something my depression has responded to in the past (but if I go too high on it I gain weight), I have never tried the other two and wonder whether there would be a difference. The reason I ask is--not to become a "me too!" gal, but along with my depression and anxiety I have ADD-ish symptoms and wondered why desipramine not clomipramine has been suggested as possible treatment. Are the SE profiles different?
In case youre wondering I am taking 15mg Lexapro, 25mg clomipramine, 40mg Geodon, 40mg amantadine.
I'm surprised so little people take Geodon. Maybe because it's a stupid name for a drug.
Anyways, thanks in advance for any thoughts....
Banga
Posted by Sad Panda on July 27, 2004, at 5:23:44
In reply to Imipramine vs desipramine vs clomipramine?, posted by banga on July 27, 2004, at 0:10:08
> Hello!
>
> Can anyone elucidate what the differences are between these three drugs? Clomipramine is something my depression has responded to in the past (but if I go too high on it I gain weight), I have never tried the other two and wonder whether there would be a difference. The reason I ask is--not to become a "me too!" gal, but along with my depression and anxiety I have ADD-ish symptoms and wondered why desipramine not clomipramine has been suggested as possible treatment. Are the SE profiles different?
>
> In case youre wondering I am taking 15mg Lexapro, 25mg clomipramine, 40mg Geodon, 40mg amantadine.
>
> I'm surprised so little people take Geodon. Maybe because it's a stupid name for a drug.
>
> Anyways, thanks in advance for any thoughts....
> Banga
>
>Imipramine was the first TCA. Clomipramine & Amitriptyline are slight alterations but completely different drugs.
Clomipramine is a potent NRI, potent SRI & potent 5-HT2A antagonist. It is possibly the best AD & is a good anxiolytic.
Amitriptyline is a potent NRI, moderate SRI, potent 5-HT2A antagonist & potent antihistamine. It is a very good AD, good anxiolytic & a great sedative.
Imipramine is a potent NRI & moderate SRI.
For side effects Imipramine is the cleanest & Amitriptyline the worst with Clomipramine in between.Desipramine is the active metabolite of Imipramine & Nortriptyline is the active metabolite of Amitriptyline.
Desipramine is a potent NRI with a very mild side effects profile which makes it a good stimulant.
Nortriptyline is a potent NRI & moderate 5-HT2A antagonist, but has more side effects than Desipramine, but less than Imipramine. It's an anxiolytic & stimulant in one package.You shouldn't really be using Clomipramine & Lexapro together as you run the risk of serotonin syndrome. Nortriptyline & Desipramine are very good when combined with an SSRI.
Cheers,
Panda.
Posted by zeebop on July 27, 2004, at 7:16:10
In reply to Imipramine vs desipramine vs clomipramine?, posted by banga on July 27, 2004, at 0:10:08
> Hello!
>
> Can anyone elucidate what the differences are between these three drugs? Clomipramine is something my depression has responded to in the past (but if I go too high on it I gain weight), I have never tried the other two and wonder whether there would be a difference. The reason I ask is--not to become a "me too!" gal, but along with my depression and anxiety I have ADD-ish symptoms and wondered why desipramine not clomipramine has been suggested as possible treatment. Are the SE profiles different?
>
> In case youre wondering I am taking 15mg Lexapro, 25mg clomipramine, 40mg Geodon, 40mg amantadine.
>
> I'm surprised so little people take Geodon. Maybe because it's a stupid name for a drug.
>
> Anyways, thanks in advance for any thoughts....
> BangaHi,
I tried all of them and this is my experience :- Clomipramine : it has side effects like SSRIs especially sexual dysfunction and bruxism.I too gained weight when I increased the dose>All in all,it is the most potent serotonergic AD in the market after paroxetine,but has a weaker NARI metabolite.
- Desipramine : is a metabolite of Imipramine and so a potent NARI . Side effects included tremor,rapid heartbeat,aggression : did not like it .
- Imipramine : is the golden one it has nearly equal potency with regards to Serotonin and Noradrenaline + less sedative than clomipramine + not too stimulating like desipramine . side effects diminished rapidly (dry mouth,fine tremor,cold feet), unlike clomipramine,no problem with sex...so it gave me within 2-3 weeks increase in concentration,loss of obsessive thoughts,diminshed anxiety,energy,drive,natural sleep,without sexual dysfunction,aggression,bruxism,apathy.The only side effect was a slight increase in appetite and some weight gain that is dose-related.
Posted by King Vultan on July 27, 2004, at 8:08:27
In reply to Imipramine vs desipramine vs clomipramine?, posted by banga on July 27, 2004, at 0:10:08
Desipramine is regarded as the best one for ADD because it is a relatively powerful norepinephrine reuptake inhibitor, but I have also seen an anecdote from an individual who found imipramine quite effective. Imipramine is a combined norepinephrine/serotonin reuptake inhibitor with other points of action also. It would be both more sedating and more anxiolytic than desipramine; it is also more anticholinergic, being especially noted for causing dry mouth. Clomipramine is a tricyclic SSRI and is quite effective in that respect but would not be particularly great for ADD, just as regular SSRIs are not indicated for this either. For ADD, it is thought that the norepinephrine system is the one that is important; serotonin is more involved with anxiety related disorders such as OCD and PTSD.
Todd
Posted by zeebop on July 27, 2004, at 9:02:57
In reply to Re: Imipramine vs desipramine vs clomipramine? » banga, posted by King Vultan on July 27, 2004, at 8:08:27
> Desipramine is regarded as the best one for ADD because it is a relatively powerful norepinephrine reuptake inhibitor, but I have also seen an anecdote from an individual who found imipramine quite effective. Imipramine is a combined norepinephrine/serotonin reuptake inhibitor with other points of action also. It would be both more sedating and more anxiolytic than desipramine; it is also more anticholinergic, being especially noted for causing dry mouth. Clomipramine is a tricyclic SSRI and is quite effective in that respect but would not be particularly great for ADD, just as regular SSRIs are not indicated for this either. For ADD, it is thought that the norepinephrine system is the one that is important; serotonin is more involved with anxiety related disorders such as OCD and PTSD.
>
> ToddMe found imipramine extremley helpful for concentration and inattention + anxiyoltic effects,without desipramine's irritations.
Posted by banga on July 27, 2004, at 22:02:32
In reply to Re: Imipramine vs desipramine vs clomipramine? » King Vultan, posted by zeebop on July 27, 2004, at 9:02:57
I appreciate the information, filing it in my bank of knowledge as I seek the miracle combination for myself. I have so many questions, will post them slowly not to hog the board!
Do any of them have any appreciable effects, I wonder if you know...from what I read, it seemed at least clomipramine had effects on D2 receptors?
I wonder how, with my mix of symptoms, Wellbutrin+ imipramine would do....Wellbutrin didnt work alone, but maybe in combo...I feel like I need to hit all 3 neurotransmitters to get real headway. The current mix is OK but I have such fog-headed/depersonalization/derealization/I cant-get-enough-coffee-into-me-to-wake-up-my-brain I am afraid I cant function at work. And no sex life (due to SSRIs that is).
Posted by Sad Panda on July 27, 2004, at 23:01:56
In reply to Thanks everyone!! Great info, posted by banga on July 27, 2004, at 22:02:32
All of the TCA's are very weak dopamine reuptake inhibitors. Nortriptyline is the best, probably about equal to the SSRI Zoloft. Combining Zoloft & Nort might give you a tiny dopamine boost, but if you really want to lift all three then the MAOI's do it evenly & this is probably why they are the best antidepressants.
Cheers,
Panda.
Posted by banga on July 28, 2004, at 0:18:18
In reply to Re: Imipramine vs desipramine vs clomipramine? » King Vultan, posted by zeebop on July 27, 2004, at 9:02:57
Thanks for the input!
How would then Nortriptyline be regarded for ADD symptomology? Isn't dopamine regulation also important for ADD? I ask because I at least in terms of Effexor didn't seem to benefit from the norepinephrine boost...but who knows? thats just one drug. And I drink coffee like you wouldnt believe-supposedly affects norepinephrine--it wires me slightly physically but its my anxiolytic like cigarettes are for others.
Posted by banga on July 28, 2004, at 0:33:19
In reply to Re: Thanks everyone!! Great info » banga, posted by Sad Panda on July 27, 2004, at 23:01:56
How tiny a dopamine boost is tiny? I mean --miniscule meaningless tiny or just less than an MAOI?
I would indeed go to an MAOI if not for partial remission from ssri/tca/atypical ap ....but as you noted the mix I take now is not the best and I have unbearable brain fog--I simply am in a dream world and I cant stand to meditate or do "be in the here and now exercises because I CANT be in the here and now. So severe brain fog and no sex drive are the main problems.I also have an anxiety component that the Geodon helps at least for now. I still dont understand that--I know it has some tiny agonistic effect on 5HT1a (according to the handy chart at www.geodon.com/MOA.asp)but all other effects are antagonistic?? No?
If they TCAs work for ADD a bit, is it not a dopamine boost? Or is it more the NE boost?
Im sorry about all the questions, no need to answer them all Im new here but intend to stick around, share what bits I have to share if it helps others.WOW! this board is so great, finally discussions I have needed.
Cheers, banga
Posted by zeebop on July 28, 2004, at 3:17:38
In reply to Thanks everyone!! Great info, posted by banga on July 27, 2004, at 22:02:32
> I appreciate the information, filing it in my bank of knowledge as I seek the miracle combination for myself. I have so many questions, will post them slowly not to hog the board!
>
> Do any of them have any appreciable effects, I wonder if you know...from what I read, it seemed at least clomipramine had effects on D2 receptors?
>
> I wonder how, with my mix of symptoms, Wellbutrin+ imipramine would do....Wellbutrin didnt work alone, but maybe in combo...I feel like I need to hit all 3 neurotransmitters to get real headway. The current mix is OK but I have such fog-headed/depersonalization/derealization/I cant-get-enough-coffee-into-me-to-wake-up-my-brain I am afraid I cant function at work. And no sex life (due to SSRIs that is).
>how about adding selegiline 5-10 mg with imipramine.by that,you get:
energy and social interaction from selegiline(DA) +
concentration,drive and motivation from imipramine (NE) +
reduction of obssesive thoughts,general anxiety and depressed symptoms from imipramine (5HT) .I tried those medications and they are old and their benefits are well-documented + they are cheap.
Posted by zeugma on July 28, 2004, at 4:22:30
In reply to Re: Imipramine vs ..King Vulcan, posted by banga on July 28, 2004, at 0:18:18
> Thanks for the input!
> How would then Nortriptyline be regarded for ADD symptomology? Isn't dopamine regulation also important for ADD? I ask because I at least in terms of Effexor didn't seem to benefit from the norepinephrine boost...but who knows? thats just one drug. And I drink coffee like you wouldnt believe-supposedly affects norepinephrine--it wires me slightly physically but its my anxiolytic like cigarettes are for others.
Nortriptyline and other NE reuptake inhibitors help ADD/concentration and boost DA along with NE because the NE transporter actually has a higher affinity for DA than NE. So in regions where DA clearance is mediated by the NE transporter (notably the prefrontal cortex) NE reuptake blockers prolong the action of DA.Also, 5-HT2A antagonism causes DA to rise in the cortex. Atypical AP's as well as TCA's do this, and this helps with the 'negative symptoms' of schizophrenia as well as depression (apathy, executive dysfunction).
Posted by Sad Panda on July 28, 2004, at 5:11:12
In reply to Re: Thanks everyone!! Great info Sad Panda, posted by banga on July 28, 2004, at 0:33:19
I don't think you want to get too excited about increasing dopamine levels, I think it overrated. Also remember that Geodeon is a dopamine receptor blocker, so taking an AP with a stimulant can be counter productive.
My first suggestion would be to swap from Clomipramine to Nortriptyline. Nort is close to Clomipramine with the SRI part removed. For side effects & weight gain I think Nort would be half as bad allowing you to take twice as much.
> I know it has some tiny agonistic effect on 5HT1a (according to the handy chart at www.geodon.com/MOA.asp)but all other effects are antagonistic?? No?
>
>I think 5-HT1A agonism causes the nerve to release less serotonin. Not 100% sure on it.
Cheers,
Panda.
This is the end of the thread.
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